411560_Well Construction - GW1_20130211

NONRESIDENTLAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2314A
1. WELL CONTRACTOR:
DAVID REGISTER
Well Contractor (Individual) Name
REGISTER WELL CO.. INC.
Well Contractor Company Name
721 WEST CHARITY ROAD
Street Address
ROSE HILL NC 28458
City or Town State Zip Code
(910 ) 289-3175
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#('It applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring [ Municipal/Public [
Industrial/Commercial [ Agricultural d Recovery [ Injection ❑
irrigation[ Other [ (list use)
DATE DRILLED 1-3-2013
4. WELL LOCATION:
HUFFMANTOWN ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: RICHLANDS couNTYONSLOW
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope [Valley wfriat ❑Ridge ❑Other
LATITUDE 34 0 557 6.8000 " DMS OR 3X.XXX)00CXXX DD
LONGITUDE 77 " 33 1 29.0000 " DMS OR 7X.XX0000(XX DD
Latitude/longitude source: ♦ iPS ❑topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
A HIIFFMAN
Facility Name
HIIFFMANTOWN ROAD
Street Address
RICHI ANDS
City or Town
A .1 HUFFMAN
Contact Name
619 BARBFE ROAD
Mailing Address
RICHI ANDS
City or Town
Facility ID# (if applicable)
NC 28574
State Zip Code
NC 98574
State Zip Code
( )
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 305
b. DOES WELL REPLACE EXISTING WELL? YES 1 NO [
c. WATER LEVEL Below Top of Casing: 73 FT.
(Use "+" if Above Top of Casing)
411.560
d. TOP OF CASING IS 1 5 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gPm) 30 METHOD OF TEST AIR
f. DISINFECTION: Type HTH Amount 4 07
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top . Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 250 Ft. 4 PVC
Top 250 Bottom 260 Ft. 4 80 PVC
Top Bottom Ft.
8. GROUT: Depth
Top 0 Bottom 20
Top Bottom
Top Bottom
Material Method
Ft. HOLE PLUG POURED
Ft.
Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 260 Bottom 305 Ft. 4 in. .015 in. PVC
Top Bottom Ft. in. In.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top 250 Bottom 320 Ft. #1
Top Bottom
Top Bottom
11. DRILLING LOG
Top Bottom
268 / 272
272 / 277
277 / 281
281 / 282
282 / 286
286 / 287
287 / 293
293 / 298
298 / 301
301 / 303
303 / 320+
12. REMARKS:
Ft.
Ft.
,EIVED
E
-":formation Processing Unit
OWQ/1.30G
Formation Description
SAND (MED FINE)
ROCK
SAND (FINE)
ROCK 4"
SAND (MED FINE)
ROCK 16" (HARD)
SAND (MED)
ROCK AND SAND (MED)
ROCK AND SAND (MED FINE)
ROCK 30" (HARD.)
SAND (VERY FINE)
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE: WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPy.Or THIS
RECO A�AOVID i0 THE 4yJ;LL O»✓Lf�.^ ®�� is
SIGNATURE OF CERTIFIED WELL CONTRAGT012
DAVID L REGISTER 7
PRINTED NAME OF PERSON CONSTRUCTING THEWELL ,
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Form GW-1 b
Rev. 2/09